Electronic health records (EHR) have come of age. Modern clinical practice requires a clinician to be mindful of best practices, and wary of excess utilization and cost. However, abundant data show that gaps exist between best evidence and practice, wide variations persist in clinical practice patterns, and escalation of healthcare costs continues largely unabated. The fundamental value proposition of IT in health care has come under increased scrutiny while it is increasingly accepted that the effective application of IT is critical for improved patient safety and quality. This application aims to better demonstrate the value of IT to the end-user clinician through creation of clinical decision support tools integrated with clinical documentation workflow, and through provision of physician performance feedback on quality and benchmarks in the EHR. We aim to demonstrate value to the clinician, as well as to the goals of patient safety and quality, and address the combined needs of clinical workflow support and decision support with innovative EHR technology. We hypothesize that two EHR-based interventions: the first focusing on the impact of a forms-based, clinical documentation-centric, approach to decision support, and the second on providing clinician specific performance reports regarding guideline compliance and quality benchmark achievement at the point of care, will significantly increase the perceived value of EHR to the end-user clinician. We propose to address three related research questions to illuminate this area of inquiry: 1) can a usable EHR intervention be developed which provides clinical decision support in the context of clinical documentation workflow, and which integrates population-based performance feedback to the physician; 2) do such tools improve the capture of key data for clinical decision support and quality assessment, compliance with best practice guidelines, and the quality of clinical documentation, and 3) is the use of such tools cost-effective - is there an impact utilization of medications, tests, and procedures in the setting of either care provided for patients with acute respiratory illness (ARI), or coronary artery disease (CAD)? We believe these are fundamental value questions which are critical to the broad adoption of IT in practice. If the end-user does not perceive the value of these tools primarily in the clinical workflow, healthcare IT will never be adopted, and secondary gains in patient safety, quality, and costs will never be achieved. [unreadable] [unreadable] [unreadable]